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Experienced mom at a loss - 6 month old not gaining well

This is my first post on this forum. What a wonderful resource! I apologize for writing a book. I just wanted to make sure I didn't leave out any details!

My 6th baby was born May 2nd. I've been breastfeeding almost non-stop (there was a 2 month break between baby #3 and baby #4) for 16 years. My babies have all been lean, but healthy. We nurse on-demand, and other than the one 2 oz bottle 5 month old baby #1 got over 15 years ago, we've never used formula.

My newest little guy was 8 lbs 8 oz at birth. He lost a little bit of weight, but was back to birth weight and gaining fairly quickly. He was 10 lbs 4 oz at 6 weeks. And then his weight slowed. Here are his weights.

His length has been consistently at the 90th percentile (he's *very* long!) and his head circumference is 50th percentile.

My baby is having plenty of wet diapers (have to change at least every 2 hours, and wakes up soaked every morning). He only poops once every week or 10 days, but doesn't seem constipated (it looks almost like pumpkin puree!)

We breastfeed *at least* every two hours during the day, and several times at night (we co-sleep). He doesn't take a pacifier, but loves, loves, loves his fingers. He vehemently refuses my right breast unless I feed him in a football hold, then he'll half heartedly eat from it. My supply is definitely less on that side.

At the baby's 5 month check up, our doctor was very concerned about the slow weight gain. He suggested supplementing with formula. I didn't want to because all of my children have food allergies and intolerances, and this baby seems to be no exception. He breaks out in rashes and gets tummy upset when I eat dairy, soy, corn, and wheat (all of which I try to avoid). Of course formula is made from most of these things!

We compromised that we'd watch things for a month while I pumped the right side to try and increase its supply, and fed the baby a bottle of this milk after he's nursed on the left side. So, that is what we did. Unfortunately, I have always had a hard time pumping, and can only get about an ounce per side. I have an Avent Isis pump, and a friend lent me her Medela bag pump - I get the same amount with both pumps. I have been pumping several times a day and saving up those ounces for one bedtime bottle (given after I have nursed on the left, and if he'll take it, right side).

My baby *loves* the bottle and gets excited when he sees it. He usually finishes the 4 oz and falls asleep.

Last week we went back to the doctor, and our baby hasn't even gained a pound this month He's around the 3rd percentile for weight, still 90th for height. The doctor is very concerned, and said the baby needs more calories or he could go into organ failure or suffer developmental and cognitive delays. We agreed to supplement with formula (we got Alimentum), and have given him one 4 oz bottle at bedtime every night since Wednesday. I have been adding a tablespoon of blueberry juice and a serving of baby probiotics to help with the *horrible* constipation and bleeding fissures that have happened since we started the formula.

Today our baby weighed 13 pounds. He gained more in the past three days than he did all of last month! So, it appears he really wasn't getting enough calories from me. I asked the doctor why this would be so when I am nursing on demand, and have successfully nursed 5 other babies, and he said he doesn't know.

So, I guess that is my question: why? It seems strange that my breastmilk would all of a sudden become less calorie dense after 16 years of successful nursing. We've had no latch issues, no reflux issues (as long as I am careful about what I eat). I don't feel like I have supply issues (I get full, and am noticeably deflated after a feeding). So, why won't my baby grow without formula?

Re: Experienced mom at a loss - 6 month old not gaining well

sounds like 14 oz?
there are constipation and bleeding fissures after only 3 days on formula??
Is he now getting 4 oz formula bottle PLUS 4 oz pumped milk, or did you drop the pumping?
have you talked to an IBCLC?

Re: Experienced mom at a loss - 6 month old not gaining well

baby gained 14 ounces in 3 days? is that even possible?

I am sorry to get so picky with the weights- I understand that is not your question, and I want to help you figure out this issue, but the weights seem REALLY wonky to me. I mean, this is not just slow gain. According to the scale, baby gained entirely normally until baby was 6 weeks old, then gained essentially nothing for the next 6 weeks- and no one was concerned at that point? If baby truly gained only 4 ounces in the second 6 weeks of life-a time when a baby typically gains 5-8 ounces per week...wouldn’t it have been really obvious something was wrong?
The gain since 3 months has been quite slow of course, but compared to those 2nd 6 weeks it is quite an improvement. Is it possible the weight check at either 6 weeks or at 3 months was simply entirely wrong?

And I cannot believe it is healthy for your baby to now be gaining almost 5 ounces a DAY… if that is even possible.

So, I am wondering first of all, if it is possible there is a scale or human error here somehow with the weight checks?

Re: Experienced mom at a loss - 6 month old not gaining well

(but - fast gain like that is possible. my ds1 gained 10 oz in 3 days, and i just talked to a mom whose baby was 6 lb 2 oz at birth and 12 lbs at 2 weeks!! even given some major scale inconsistencies, that's probably 5 oz/day)

Re: Experienced mom at a loss - 6 month old not gaining well

Ok, I was thinking about this all night. Well, I DID sleep but you know what I mean....

First off:

(but - fast gain like that is possible. my ds1 gained 10 oz in 3 days, and i just talked to a mom whose baby was 6 lb 2 oz at birth and 12 lbs at 2 weeks!! even given some major scale inconsistencies, that's probably 5 oz/day)

Very rapid weight gain may & often does happen in the first few weeks or couple of months, when average gain is about an ounce a day. But at 6 months? That is a very different time, as far as normal, average weight gain goes. But you are right, I really don't know if it is unhealthy. I should not have said that in my pp.

OK, here is what I wondered last night: miss.jeni, your baby suddenly started gaining not just normally but incredibly fast after starting formula. Way faster, imo, than could be explained by ONLY the calories in the few ounces of formula you give your baby each day.-4 ounces, right?

Most formulas contain added iron and other nutrients. I wonder if there was a nutritional deficiency all along that is now being addressed by the added formula?

The way I understand it, there is no such thing as ‘low cal’ breastmilk. Fat content in breastmilk varies, even over the course of a feeding or over the course of the day, but there is always some fat. A baby may not gain well due to not getting enough milk. But they also may not gain well due to illness or allergy or a nutritional deficiency. (For example, low iron, low B12) Was your baby ever tested for any illness etc?

If the issue is not enough milk, there are three general reasons a baby does not get enough milk- 1) baby not nursing often enough 2) poor milk transfer (baby cannot nurse effectively for some reason) or 3) low milk production. Any of these can occur in combination as well.

Once it is figured out which of these may be going on, the issue can be addressed and possibly solved.

Re: Experienced mom at a loss - 6 month old not gaining well

Thank you all *so* much for responding!!

Yes, he gained 14 oz since Wednesday (actually I weighed him on my scale at home today and he gained another 2 oz yesterday, so that is a total of 16 oz - assuming the doctor's scale and our scale are calibrated the same). This was from adding only one 4oz bottle of formula a day. I have kept pumping, but am storing the milk since I don't want to give him more than one bottle a day. That weight gain seemed high to me to, but that's what the scale said

Poor baby was constipated and bleeding with the first poop after starting formula (the next day). He went from one poop every 7 - 10 days, to one very firm one every day. I say constipated, but what I really mean is a very firm poop eliminated with grunts, high pitched shrieks, and fresh blood (which the dr. said came from fissures). I don't mean to say he *can't* go, rather it is painful for him.

His 6 week weight was with my midwife (we had a homebirth), and the 12 week weight was with our doctor. It *is* possible they were a little off because of different scales, but probably not greatly so. At first, the doctor just assumed the midwife's numbers were off, but when the continued pattern of slow weight gain continued during the next two months he became concerned. Honestly, my dh and I were pretty shocked by the 12 week weight. We weren't weighing him at home, and while he seemed skinny, like my other children, he didn't seem *that* small. Also, he was growing lengthwise. He grew about 3 inches in those 6 weeks, which I think made him seem bigger than he was.

A nutritional deficiency could definitely make sense in this situation. Though, I am eating a whole foods diet with meat. I take vitamin d3 and calcium supplements + a prenatal every day. But, if he's not absorbing nutrients for some reason, I guess my diet wouldn't necessarily matter.

Our little guy has never been tested for any illness, allergies etc. Other than the weight gain issue he is healthy and happy. He had a little old at 4 months, but got over it quickly and didn't develop an ear infection or anything like that. I strongly suspect food allergies or intolerances, but my own elimination diet experiment is the only "proof" we have of that. He has developed a mild face rash since starting the formula, but it is Alimentum, so that may just be a coincidence.

I have not seen an IBCLC. I had really thought nursing was going well. We didn't have any pain, latch, or thrush issues. He wasn't tongue tied. He feeds often and has lots of wet diapers. He nurses until he's done, and doesn't seem hungry in between feedings. But, obviously something serious is going on. I'd hoped increasing the supply on my right side (the side he refuses) and feeding the bottle of ebm would fix his weight gain problem (that seemed like a logical suggestion!), but he seems perfectly happy to nurse primarily on the left side and doesn't seem hungry when he's done.

I really appreciate you all taking the time to read all of this and sharing your thoughts!

Re: Experienced mom at a loss - 6 month old not gaining well

You are an experienced breastfeeding mom. So you have not only your instincts to go by-and those are important- but also your personal experience. So I think that either 1) the situation was/is not as dire as it looks on paper or 2) something very unusual was/is going on.

As far as looking for answers, it may help to just think about your options. On the one hand, things are certainly looking very positive, a huge turnaround, with the addition to baby's diet of just a little formula. Assuming your baby's gain continues to normalize, you can just let this go, and, if you wish, discuss with your child’s doctor if you can go back to supplementing with your own milk (or not supplementing at all) in time. I would only caution that IF there are underlying health issues, formula is not going to necessarily fix those. And, as you get into solid introduction and the typical slowing of gain as baby becomes more & more mobile, the weight gain issue may keep coming up with your son's doctor.

On the other hand, assuming you can, do you want to ask for tests? See a nutritionist, allergist, or other specialist? Unfortunately, looking for answers may mean having to defend your feeding choices which can be very unpleasant. The propensity among many medical professionals to blame breastfeeding for weight gain issues may even lead some mothers to the point of lying about what they are feeding their child in order to get tests done.

I think seeing an IBCLC may give you some answers. It will be hard to go back now and try to figure out what may have caused baby to stop gaining normally somewhere around 4 to 6 weeks of age, but you may be able to at least rule out any current latch/nursing effectiveness/supply issues.

btw Differences in scale can dramatically affect weight check numbers, as can human error. It happens more often than you would expect.

At this point, unless low production is likely, pumping is really only needed to 'offset' the formula supplements so your milk production is not harmed by supplementing.

Re: Experienced mom at a loss - 6 month old not gaining well

i agree with all of that, and especially want to echo the bit about preparing for the normal slow in growth around 6 months. it might be worth having a conversation with baby's doc now, in advance, about what kinds of signs & benchmarks you will want to see, to hopefully head off any disagreement down the road. such a strange situation! good luck!

Thank you so much for this link! It was very helpful Also, thank you for your advice. I am going to call my midwife tomorrow and get the name of an IBCLC. At least we can hopefully rule out some things. I would really like to find the cause of our baby's weight gain issues, so we can make sure we aren't just band-aiding a more serious problem.

Originally Posted by @llli*auderey

It might be worth having a conversation with baby's doc now, in advance, about what kinds of signs & benchmarks you will want to see, to hopefully head off any disagreement down the road.